Provider Demographics
NPI:1396730172
Name:MORAITIS, PHILIP (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:
Last Name:MORAITIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3640 MAIN ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1145
Mailing Address - Country:US
Mailing Address - Phone:413-739-7367
Mailing Address - Fax:413-737-2686
Practice Address - Street 1:3640 MAIN ST
Practice Address - Street 2:SUITE 205
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1145
Practice Address - Country:US
Practice Address - Phone:413-739-7367
Practice Address - Fax:413-737-2686
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA79560174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA779560OtherCONNECTICARE
MAJ14560OtherMA BLUE SHIELD
MA079560OtherTUFTS
MAP1644826OtherOXFORD HEALTH PLANS
MA0115328OtherAETNA GROUP NO.
MA3152250002OtherCIGNA
MA010079560MA01OtherCONNECTICUT BLUE SHIELD
MA151179OtherHARVARD PILGRIM
MA180026086OtherRAILROAD MEDICARE
MA080434OtherUNITED HEALTH CARE
MA18478OtherHEALTH NEW ENGLAND
MA3152250002OtherCIGNA
MAF79997Medicare UPIN